摘要
目的探讨飞秒激光辅助白内障手术对轴性高度近视患者白内障术后囊袋-人工晶状体(IOL)复合体演变的影响。方法前瞻性选取2023年7月至2024年12月在温州医科大学附属眼视光医院杭州院区接受白内障手术的轴性高度近视(眼轴>26 mm)患者31例44眼。根据患者自愿原则选择手术方式,其中飞秒激光辅助组17例24眼,传统超声乳化组14例20眼。分别于术后1 d、1周、1个月和3个月进行随访,所有患者接受常规眼科检查后散瞳至直径6.5 mm以上再行扫频光学相关断层扫描仪扫描,所得图片用于分析囊袋-IOL复合体相关参数,包括前囊口直径、囊袋弯曲指数(CBI)、术后前房深度(PAD)及水平位和垂直位IOL倾斜度及偏心量变化情况[采用倾斜度均方根(TRMS)和偏心量均方根(DERMS)来体现IOL的倾斜度和偏心量的变化]。结果两组患者术后不同时间点前囊口直径比较差异均无统计学意义(均P>0.05)。两组患者术后1个月前囊口直径均低于术后1周(均P<0.05),术后1个月趋于稳定。飞秒激光辅助组患者术后1个月CBI高于传统超声乳化组(P<0.05)。两组患者术后3个月内CBI均呈上升趋势,术后1 d<术后1周<术后1个月<术后3个月(均P<0.05)。两组患者术后不同时间点PAD比较差异均无统计学意义(均P>0.05)。飞秒激光辅助组患者术后1周PAD小于术后1 d(P<0.05),术后1周趋于稳定,传统超声乳化组患者术后1个月内PAD变化明显(均P<0.05),术后1个月后趋于稳定。两组患者术后不同时间点水平位和垂直位TRMS和DERMS比较差异均无统计学意义(均P>0.05)。结论轴性高度近视白内障患者飞秒激光白内障术后早期囊袋弯曲形成速度普遍快于传统超声乳化组。相较于传统超声乳化组,飞秒激光辅助组IOL轴向运动稳定时间提早,而术后IOL倾斜度和偏心量无明显优势。
Objective To investigate the effect of femtosecond laser-assisted cataract surgery on the evolution of the capsular bag-intraocular lens(IOL)complex after cataract surgery in patients with axial high myopia.Methods A prospective study included 31 patients(44 eyes)with axial high myopia(axial length>26 mm)who underwent cataract surgery at the Hangzhou Campus of Eye Hospital of Wenzhou Medical University from July 2023 to December 2024.According to the patients'voluntary choice of surgical method,17 patients(24 eyes)were assigned to the femtosecond laser-assisted group,and another 14 patients(20 eyes)were assigned to the traditional phacoemulsification group.Follow-ups were conducted at 1 day,1 week,1 month,and 3 months postoperatively.After routine ophthalmic examinations,all patients were dilated to a pupil diameter of>6.5 mm,followed by swept-source optical coherence tomography(SSOCT)scanning.The obtained images were used to analyze parameters related to the capsular bag-IOL complex,including anterior capsular opening diameter,capsular bend index(CBI),postoperative anterior chamber depth(PAD),and changes in horizontal and vertical IOL tilt and decentration[represented by the root mean square of tilt(TRMS)and the root mean square of decentration(DERMS)].Results There were no statistically significant differences in the anterior capsular opening diameter between the two groups at different postoperative time points(all P>0.05).In both groups,the anterior capsular opening diameter at 1 month postoperatively was lower than that at 1 week postoperatively(both P<0.05),and it stabilized at 1 month postoperatively.The femtosecond laser-assisted group had a higher CBI at 1 month postoperatively than the traditional phacoemulsification group(P<0.05).The CBI increased within 3 months postoperatively in both groups,with the order of 1 day<1 week<1 month<3 months postoperatively(all P<0.05).There were no statistically significant differences in PAD between the two groups at different postoperative time points(all P>0.05).In the femtosecond laser-assisted group,PAD at 1 week postoperatively was smaller than that at 1 day postoperatively(P<0.05),and it stabilized at 1 week postoperatively.In the traditional phacoemulsification group,PAD changed significantly within 1 month postoperatively(all P<0.05),and it stabilized after 1 month postoperatively.There were no statistically significant differences in horizontal and vertical TRMS and DERMS between the two groups at different postoperative time points(all P>0.05).Conclusion In patients with axial high myopia,the early formation rate of capsular bag bending after femtosecond laser cataract surgery is generally faster than that after traditional phacoemulsification.Compared with the traditional phacoemulsification group,the femtosecond laser-assisted group has an earlier stabilization time of IOL axial movement,but the group shows no obvious advantage in postoperative IOL tilt and decentration amount.
作者
丁锡霞
王丹丹
常平骏
胡逸文
杨馥蔓
傅亚娜
DING Xixia;WANG Dandan;CHANG Pingjun;HU Yiwen;YANG Fuman;FU Yana(Cataract Clinical Center,Hangzhou Campus of Eye Hospital of Wenzhou Medical University,Hangzhou 310020,China)
出处
《浙江医学》
2025年第12期1288-1293,共6页
Zhejiang Medical Journal
基金
浙江省医药卫生科技计划面上项目(2021KY217)
温州市科技局基础性公益科研项目(2024Y1221)。
